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Zap that mos quit o ga safe me Zika, dengue and chikungunya safe A re m o yo u squ f r e i to e? sa fe fe pick sa up c safe prevention toolkit Sta rst ta In partnership with RED CROSS/RED CRESCENT C L I M AT E C E N T R E The Netherlands Red Cross Use stic ky-t ape to tap e th e tw o pie ces of th em osq uito gam e to geth er. rt

Acknowledgments Foreword This toolkit was made possible by the European Union funded International Consortium on dengue Risk Assessment, Management and Surveillance (IDAMS), a five and a half research project led by Heidelberg University Hospital. Further we would like to thank the IDAMS partners and, in particular, Leigh Bowman from Liverpool School of Tropical Medicine for their support to the development of this toolkit. Authors: Nancy Claxton, Ed.D. & Kelly Macias Instructional Design: Nancy Claxton, Ed.D. Project Managers: Amanda McClelland, IFRC & Fleur Monasso, Red Cross and Red Crescent Climate Centre Pilot Testing: Amiel John Badillo, Philippine Red Cross, Ormoc Chapter Michelle Anoba, Philippine Red Cross, Ormoc Chapter Reviewers and Advisors: Sandra Arbid, IFRC MENA Leigh Bowman, Liverpool School of Tropical Medicine Erin Coughlan de Perez, Red Cross and Red Crescent Climate Centre Jorge Jose Huarachi, Bolivian Red Cross Ryan Jay Jopia, Philippine Red Cross Axel Kroeger, World Health Organisation Amanda McClelland, IFRC Geneva Fleur Monasso, Red Cross and Red Crescent Climate Centre Mónica Posada, IFRC Wbeimar Alejandro Sánchez Bustamante, IFRC Americas Through the 2016 declared outbreak of Zika, the bite of an infected Aedes Aegypti and Aedes Albopictus mosquito grew even more hazardous. These same Aedes mosquitoes that transmit Zika also transmit dengue, chikungunya and yellow fever, diseases that affect all segments of society but with particular impact on the poorest and most vulnerable. Diseases caused by the Aedes mosquitoes result in hundreds of thousands of deaths each year deaths which are largely preventable by eliminating mosquito breeding sites and interrupting human-to-mosquito contact. In the battle against diseases like Zika and dengue, knowledge is power. Climate change is shifting the distribution of mosquitoes and to new areas. Empowering communities is essential in reaching and protecting the most vulnerable individuals and households. Vector control programmes, community empowerment and awareness campaigns are proven strategies to reduce the burden of vector-borne diseases. Red Cross and Red Crescent volunteers can play a key role in community and school outreach activities for Zika, dengue and chikungunya prevention. These community-based activities need to be sustained to ensure long-lasting disease control. The Zika, dengue and chikungunya prevention modules and toolkit were developed to initiate a long-term engagement with the communities at risk through awareness and health promotion materials. National Societies and organizations at community level can contribute to sustained improvement of sanitation, reduction of mosquito breeding sites and increased level of knowledge on how to protect the community from mosquito-borne diseases such as Zika, dengue and chikungunya. It is our hope that these materials will start the necessary conversations with communities and school communities to recognise that prevention is the best weapon in the battle against the threats posed by Aedes mosquitoes. We invite all partners within and outside the Movement to adapt and use these materials to empower your communities with the knowledge, skills and behaviour necessary to reduce vector-borne disease transmission for healthier and happier communities. Graphic Design, Production and Layout: Marcel Claxton Julie Lyn Hall, M.D., MPH, MBE Director of Health & Care International Federation of Red Cross and Red Crescent Societies Geneva, Switzerland Maarten van Aalst, Ph.D. Director Red Cross / Red Crescent Climate Centre The Hague, Netherlands

RED CROSS/RED CRESCENT RED CROSS/RED CRESCENT RED CROSS/RED CRESCENT The Netherlands Red Cross CLIMATE CENTRE The Netherlands Red Cross The Netherlands Red Cross In partnership with Are you mosquito free? safe Introduction The Zika, dengue and chikungunya prevention modules and toolkit Community module Zika, dengue and chikungunya prevention community module CLIMATE CENTRE The Zika, dengue and chikungunya prevention community module is intended for volunteers teaching and coaching adults (ages 17 +) about the transmission, symptoms, treatment and prevention methods to address Zika, dengue and chikungunya (ZDC). The community module is comprised of 5 topics which we advise teaching in sequential order for maximum effect. The included tools, talking points and activities allows volunteers to teach communities in an interactive way about how ZDC is transmitted, how to prevent mosquito bites and reduce mosquito populations through community action and social and behavior change techniques as well as what to do if a community thinks they may have contracted Zika, dengue or chikungunya. The materials also address stigma associated with ZDC and helps to set a supportive environment for preventing disease as a collective group through ongoing community action. Topic outline for community and school/youth modules Topic 1 - Let s learn about diseases spread by Aedes mosquitoes Topic 2 - Know the risks of Zika, dengue and chikungunya Topic 3 - Know where mosquitoes breed and live in the community Topic 4 - Preparing for and preventing Zika, dengue and chikungunya Topic 5 - Creating an action plan Zika, dengue and chikungunya prevention school/youth module CLIMATE CENTRE School/youth module The Zika, dengue and chikungunya prevention school / youth module is intended for volunteers, educators, and peer educators teaching children from ages 7-16 in a school or youth club setting about the transmission, symptoms, treatment and prevention methods to address Zika, dengue and chikungunya (ZDC). The school / youth module is comprised of 5 topics which should be taught in sequential order. The included tools, talking points and activities allows children to learn in an interactive way about how ZDC is transmitted, how to prevent mosquito bites and reduce mosquito populations through collective school community action and social and behavior change techniques as well as what to do if a child suspects that s/he or a family member thinks they may have contracted Zika, dengue or chikungunya. The materials also address stigma associated with ZDC and help to set a supportive environment for preventing disease as a collective group through ongoing school community action. Zika, dengue and chikungunya prevention toolkit safe Zap that mosquito game safe safe Start pick up card pi Toolkit The Zika, dengue and chikungunya prevention toolkit is intended to be used with the Zika, dengue and chikungunya prevention modules. The toolkit features full-colour imagery, interactive formats and games material to teach all audiences according to the methodology suggested in the module guides. All materials can be printed in colour or black/white and are of high resolution for those national societies wishing to enlarge and print posters and banners for other uses in their Zika, dengue and/or chikungunya prevention activities.

Table of contents Topic 1 Topic 2 Mosquitoes poster Transmission card Symptoms board (left/right) Symptoms cards Treatment card Untreated disease board Untreated disease cards Microcephaly card Pregnant woman card Breeding sites board (left/right) Breeding sites cards Prevention board (left/right) Prevention cards Breeding site posters for discussion #1 Breeding site posters for discussion #2 Breeding site posters for discussion #3 Breeding site posters for discussion #4 School map with no flags (left/right) School map with green flags School map with green and red flags Community map with no flags (left/right) Community map with green flags Community map with green and yellow flags Community map with green, yellow and red flags Mapping flags - school/youth Mapping flags - community A buzz about dengue game cards 1 (front/back) A buzz about dengue game cards 2 (front/back) A buzz about dengue game cards 3 (front/back) A buzz about dengue game cards 4 (front/back) A buzz about dengue game cards 5 (front/back) A buzz about dengue game instructions Charades clues cards Zap that mosquito game cards Topic 3 Topic 4 Mosquitoes and eggs poster Zap that mosquito game board (top/bottom) Community poster Zap that mosquito game die Addressing stigma roleplay cards #1 Addressing stigma roleplay cards #2 Note: Topic 5 does not use any tools from the toolkit.

Aedes Aegypti Aedes Albopictus

Symptoms board Dengue, chikungunya and Zika (all) Dengue

Use sticky-tape to tape the two pieces of the board together. Now stick the Symptoms cards on the spot underneath the appropriate virus you think the symptom belongs to. Dengue, chikungunya and Zika (all) and chikungunya Zika (only)

Symptoms cards Cut out the cards along the dotted lines. Fever Skin rash Joint/muscle pain Headache Swollen glands Red swollen eyes Pain behind the eyes Some bleeding from the nose and gums Stomach pain Vomiting blood or vomiting that doesn t stop Difficulty or fast breathing Extremely tired Nauseous or feel like you want to vomit

Untreated disease board Stick the Untreated disease cards on the spot underneath the appropriate disease you think it belongs to. Dengue Chikungunya Zika

Untreated disease cards Cut out the cards along the dotted lines. Feeling very sick Possible death Feeling very sick Very painful Microcephaly Guillain-Barré

Breeding sites board Indoors

Use sticky-tape to tape the two pieces of the board together. Now stick the Breeding sites cards on the spot underneath the appropriate location you think it belongs to. Outdoors

Breeding sites cards Cut out the cards along the dotted lines. Rain barrel Drum Pot Bucket Flower vase Plant storage bin Empty bottle Tire Bathtub Outdoor water cistern Outdoor well Standing pool of water Creek or still river

Prevention board Prevention methods

Use sticky-tape to tape the two pieces of the board together. Now stick the Prevention cards on the board. Prevention methods

Prevention cards Cut out the cards along the dotted lines. Empty standing water Scrub inside of containers every week Use insect repellent Wear long sleeves and pants Sleep under a bednet between dawn and dusk Demand larvicide or fogging at school and community

Mapping flags - school/youth Cut the flages out along the dotted lines.

Mapping flags - community Cut the flages out along the dotted lines.

A buzz about dengue game cards 1 (front) Cut out the cards out so you have eight in total. WEARING LONGSLEEVE CLOTHING GIVING PARACETAMOL AND LOTS OF FLUIDS TO A PATIENT HOUSE-TO-HOUSE CALLING TO REPORT ABOUT CASES AND WHAT TO DO SPRAYING INSECTICIDE ON THE TREATED SCREENS IN DOORS & WINDOWS ADVOCATING FOR WEEKLY FOGGING ACTIVITIES DURING AN OUTBREAK.. MOBILIZING SCHOOL GROUPS FOR LOCAL CLEAN-UP CAMPAIGNS ADVOCATING FOR IMPROVEMENT OF THE WASTE MANAGEMENT BRINGING BUG SPRAY TO PATIENTS AND THEIR FAMILY

A buzz about dengue game cards 1 (back) Cut out the cards out so you have eight in total. HUMANS! This is a reasonably good measure as humans are better protected, but since the mosquito is resting indoor, spraying in house is also needed. HUMANS! Standing water in street rubbish can enable breeding sites. School clean-up activities help to protect the community and at the same, creates awareness of the risks of dengue. (Note: picking up the garbage alone does not necessarily contribute to reducing dengue, e.g. no standing water or productive pupa). HUMANS! This a very good measure, waste can become breeding sites due to standing water, so if waste is better managed, mosquitoes have less options to breed. HUMANS! This a reasonably good measure, especially if people in the family/ neighborhood are infected, others can protect themselves against mosquitoes bites by using the spray. HUMANS! This is reasonably good measure as it is harder for mosquitoes to bite you, but it is not a 100% protection. HUMANS! Good, paracetamol will fight the fever and fluids to avoid dehydration. (Note: never give aspirin to a dengue patient, it is DANGEROUS!) HUMANS! A very good measure as people will be better aware of the risks and ways to prevent dengue. Advise friends and family of warning signs for dengue: abdominal pain/tenderness; persistent vomiting; bleeding from mucosa; and lethargy/restlessness. HUMANS! A good measure, in this way the mosquitoes will enter or breed less inside the house, which will protect the family when they are indoors.

A buzz about dengue game cards 2 (front) Cut out the cards out so you have eight in total. USING BUG SPRAY INDOORS ON FURNITURE & DARK CORNERS PLACING MESOCYCLOPS OR LARVICIDES IN STANDING WATER SETTING UP A LOCAL DENGUE STEERING COMMITTEE ENCOURAGING THE REPORTING OF DENGUE CASES TREATING BEDNETS WITH INSECTICIDE, ESPECIALLY FOR CHILDREN S NAPS COVERING WATER STORAGE WITH TIGHT LIDS SEEKING MEDICAL CARE FOR FRIEND & FAMILY WITH SYMPTOMS APPLYING BUG REPELLENT EACH MORNING ON THE SKIN...

A buzz about dengue game cards 2 (back) Cut out the cards out so you have eight in total. HUMANS! As children nap during the day, mosquitoes seek chances to bite. Children are more vulnerable and severe dengue fever is dangerous for them. HUMANS! A good measure, water storages are an ideal places for mosquitoes to lay eggs. By covering them, the mosquitoes can no longer breed there. HUMANS! Medical attention is needed when dengue develops into severe hemorrhagic fever. Hospitals are aware of the cases in the area. HUMANS! When humans use bug repellent, they protect themselves against the mosquitoes. It still doesn t mean their 100% safe. HUMANS! A reasonably good measure, by spraying furniture and corners indoors you make sure the mosquitoes do not want to breed and hide there. HUMANS! Mesocyclops prey on mosquitoes larvae, so by putting it in standing water, the breeding places will be cleaned up. HUMANS! When people are in charge they can make sure the whole community can be protected. (organizing clean-up, advocating, etc.) HUMANS! Reporting dengue cases to local authorities is very important since it can stimulate further discussions on protection in the community and identify possible neglected breeding sites in the neighbourhood.

A buzz about dengue game cards 3 (front) Cut out the cards out so you have eight in total. INVOLVING PRIVATE SECTOR, LOCAL GOVERNMENT OFFICES AND HOSPITALS INTO COMMUNITY DENGUE STEERING GROUPS NEW BREEDING SITES CAUSED BY RAINY SEASONS. NEGLECTING THE CLEAN UP AROUND THE LIKELY INFECTED NEIGHBOR S PROPERTY HIGH-DENSITY NEIGHBORHOODS STORING WATER UNPROPERLY FORGETING TO CHECK NEIGHBORHOOD WATER CONTAINERS. ENJOYING A LATE AFTERNOON NAP WITHOUT A BEDNET. CHECKING STANDING WATER EVERY 2 MONTHS FORGETING TO CLEAR THE STANDING WATER THIS WEEK

A buzz about dengue game cards 3 (back) Cut out the cards out so you have eight in total. MOSQUITOES! It is a perfect place to breed, so if this is not done, the mosquitoes can spread easily. MOSQUITOES! It is easier for the mosquitoes to bite when humans are not using bed nets. MOSQUITOES! Standing water should be checked must more often as eggs will become full grown mosquitoes in approx. 10 days MOSQUITOES! Eggs will become full grown mosquitoes in approx. 10 days, so it is better to not skip a week. HUMANS! Multiple stakeholder dialogue and action can enhance the work of the community dengue steering committee., (note: health sector should be represented) MOSQUITOES! When the rain is not drained well, it can create a lot of standing water. Perfect for the mosquitoes to breed. MOSQUITOES! If the neighbor is ill, there are likely breeding places close by as the mosquito usually bites/- feeds no further than 200 metres from his breeding place. Breeding places should be traced & cleaned before other people get infected too. MOSQUITOES! This will make for perfect breeding places and since it is high density area, a lot of people can get bitten by the mosquitoes.

A buzz about dengue game cards 4 (front) Cut out the cards out so you have eight in total. STANDING POOLS IN STREAMS DUE TO DROUGHT AND MORE WATER STORING... MORE INFECTED PEOPLE FLYING ON PLANES BRINGING DENGUE HEAVY RAIN & NEGLECTING TO CLEAN DITCHES LEAVING OLD TIRES LYING AROUND OUTSIDE... MORE STANDING WATER SITES CAUSED BY URBANISATION IGNORING A SICK FAMILY MEMBER S SYMPTOMS NOT TREATING BED NETS AND DOOR WITH INSECTICE, HOLES LOOSE REFUSE WHICH IS GREAT FOR BREEDING SITES...

A buzz about dengue game cards 4 (back) Cut out the cards out so you have eight in total. MOSQUITOES! Urbanisation can lead to more standing water sites, given the mosquitoes more chance to breed MOSQUITOES! By ignoring the symptoms they put them selves at a higher risk of dengue. People need to act upon potential infection and eliminate breeding sites near by to avoid further transmission MOSQUITOES! It is better to treat the bed nets and the curtains of open doors with insecticide to keep mosquitos out and to repair them when needed. MOSQUITOES! More possibilities for breeding sites in standing water MOSQUITOES! Streams dry up slowly, leaving perfect pools of standing water for the mosquitoes to breed in, as well as the increased water storage without taps. MOSQUITOES! Dengue has spread enormously over the past decade. Over half of the worlds population is now prone to dengue. Global travel has contributed to this spread, amongst other factors like urbanization and climate change. MOSQUITOES! By not cleaning the ditches, the water can not flow and will create nice pools for the mosquitoes to breed. (Note: heavy rain which leads to often flushes out breeding sites) MOSQUITOES! Tires are perfect places for mosquitoes to breed.

A buzz about dengue game cards 5 (front) Cut out the cards out so you have eight in total. A LIKELY INFECTED NEIGHBOR S PROPERTY THAT IS FULL OF TRASH MORE HUMANS IN CLOSE PROXIMITY DUE TO URBANISATION

A buzz about dengue game cards 5 (back) Cut out the cards out so you have eight in total. MOSQUITOES! Trash is a perfect place to breed and since the person is ill, there are likely dengue mosquitoes in close proximity. MOSQUITOES! These can infect more people in the same time, in comparison to less densely populated areas.

A buzz about dengue game instructions A buzz about dengue: Cross serious game Designed by Janot Mendler de Suarez and Pablo Suarez* Objective of the game This game aims to create awareness on the characteristics of the dengue disease while providing useful information on how to uce the risk of infection through community mobilization and organization. The game can be played with communities as risk as a tool to engage in discussion and local decision making on response and prevention of vector-transmitted diseases (as it can be adapted for chikungunya). Goal of the game Humans try to prevent dengue outbreaks by protecting themselves from Mosquito bites and by cleaning up breeding grounds. On the other hand, Mosquitoes try to infect Humans by biting them, and try to multiply by laying more eggs in their nice wet breeding grounds. The team who wipes out the other team or with more beans (blood/eggs) wins! Materials: Deck of cards print the document double sided over the long edge. Stack of dry beans (minimum of 50) Setup of the game Minimum 6 players, forming 2 teams of 3 (3 players are Humans and 3 players are Mosquitoes). Teams face off across a table, more groups of 6 can play in parallel. The mosquito team gets 5 beans; the human team gets 11 beans. Each team divides these beans among players as they wish, but the opposing team must not see which player is holding how many beans! The table between the teams represents potential Mosquito Breeding Grounds in the middle of the table. To start the game, 12 beans are grouped into 3 Breeding Grounds, each one with 4 beans. There is one deck of cards. The facilitator will shuffle and hold the deck of cards. On the cards are scenarios or actions indicated that can be off benefit to the Humans or the Mosquitoes. When using the cards, the facilitator can ask the basic question: Which group will benefit from? Gameplay Each player can make use of two different actions, one action at a time: Human Protect: The player crosses hands over the chest Clean: The Player points at one breeding ground on the table Mosquitoes Bite: The player point across the table to one of the human players Breed: The player points at one breeding group on the table The rounds of the game are played very quickly (like a game of Rock, Paper, Scissors!). The players of each team can strategize for 1 minute on which action will they take on each round. The 11 beans protect Humans from getting dengue; as long as a Human has at least 1 stone, they are healthy enough to protect or recover from a bite, but with each successful bite, the Mosquito takes a blood stone!. On the other hand, the 5 beans to allocate as they wish among the 3 team members. Mosquitos holding beans may choose whether to bite or breed in the Breeding Grounds. Players without beans have only one option, to bite a human. SCENARIO CARDS/ACTION CARDS PLAY: The facilitator has a deck of 34 cards. In this deck there are 17 positive scenarios/actions cards for the humans and 17 positive scenarios/actions cards for the mosquitoes. After playing the game 4 rounds without cards, the facilitator will play a card after each round of actions (Breed/Bite, Protect/Clean). After a card question, the teams must quickly answer who the card has a positive outcome and that team will get an extra stone (representing healthy blood or eggs). The Mosquitoes can request to answer by buzzing and the human can request to answer by clapping at the mosquito. Considerations When a mosquito bites a human who is not protected, but choose to clean up, he will take a stone from the human. However when a mosquito bites a human who is protected, nothing happens. When a human chooses to clean up a breeding site, he/she takes a stone from the breeding ground he/she was pointing at. The stone moves to the side and is no longer used in the game. If at the same time a mosquito chosen to breed in that same breeding ground, he/she puts the stone that he is holding in the breeding ground. The amount of beans in the breeding ground does not change, but there is one stone less in the game. The facilitator will pick a card from the deck and reads it out loud. The group then decides if the card is in favor of the Mosquitoes or in favor of the Humans. When this is decided, the facilitator can give extra information when requi and afterwards gives the winning team an extra stone. They can then decide who is going to get it among themselves. * adapted from original Humans vs. Mosquitoes game, designed by Clay Ewing, Lien Tran, Mohini Freya Dutta, Ben Norskov, Eulani Labay, Sophia Colantonio, Lauren Graham, Vanessa Lamers, and Kanchan Shrestha, in consultation with Janot Mendler de Suarez and Pablo Suarez.

Charades clues cards Cut out the cards along the dotted lines. Mosquito eggs Scrub inside of water containers Dump standing water Zika virus Dengue virus Outdoor water storage cistern Mosquito bite Chikungunya virus Insect repellent Red Cross / Red Crescent volunteer Wear long sleeves Vaccine

Zap that mosquito game cards Cut out the cards on the dotted lines. Rain barrel Drum Garbage in bin Pot Bucket Insect repellent Flower vase Plant storage bin Bednet Empty bottle Insect repellent Cover water container Bathtub Empty containers Long sleeves / pants Standing water Scrub inside containers Fogging/larvicide Tire Bednet Long sleeves / pants

Zap that mosquito game Use sticky-tape to tape the two pieces of the game board together. Finish Are you mosquito free? used card pile e f a s safe

sa fe pick up card pile e saf safe StartStart

Zap that mosquito game die Cut the shape out on the dotted lines to get one shape. Fold each square wih a number inward so the die forms a cube with the numbers on the outside. Tape the edges to make a solid die. 1 1 2 1 2 3

Addressing stigma roleplay cards #1 Cut out the cards along the dotted lines. Juan You are a sick boy who does not feel well. You get mosquito bites every night even though you sleep with a bednet. You feel hot and have a terrible headache. You tell your friends, Hector and Fatima that you cannot play at recess you don t feel so well. Hector You are friends with Juan and he looks terrible. You don t want to get dengue and die like your uncle. When Juan comes towards you, you tell him to stay back that he might infect you with dengue. You are terrified of catching a disease from Juan. Fatima You are worried about Juan he doesn t look so good. You are shocked at how Hector is behaving because you know that someone can only get dengue if they are bitten by an Aedes Aegypti or Aedes Albopictus mosquito with the virus. You tell Hector and Juan how someone can get dengue and what happens when a person gets dengue. You put your arm around Juan to help him go to the teacher so he can get to the clinic or doctor.

Addressing stigma roleplay cards #2 Cut out the cards along the dotted lines. Esmeralda Your mother is pregnant and has not been feeling well. Even though your mom says that she did not get bit by a mosquito, everyone at school says that your mom has Zika and your baby sister will have a small head. That hurts you to think about what might happen to your family. Jose You are afraid of Esmeralda, whose mom probably has Zika. Your mom told you so. You tell the other kids that Esemeralda probably has Zika too that everyone should stay away from Esmeralda or they will get Zika and die. You tell DeeDee all about Esmeralda s mom. DeeDee You are not afraid of Esmeralda and you feel sorry for her mom. You know that you can only get Zika if you are bitten by an Aedes Aegypti or Aedes Albopictus mosquito with the virus. You are nice to Esmeralda and tell her that you hope her mom gets better. You tell Jose how he can get Zika and how he cannot get Zika. You tell Jose to stop being mean to Esmeralda and you tell Esmeralda to get her mom to a clinic or a doctor.